Job Description
Support comprehensive coordination of medical services for the Medicare Serious Illness population, including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.
Fundamental Components
Responsible for triaging incoming calls for the Seriously Ill population and triaging calls to the correct care team member, and initial review and triage of Care Team tasks.
Make appropriate referrals to medical services staff and assist with coordination of the required services.
Assist to support the Development and Implementation of Care Plans. Coordinates and arranges for health care service delivery under the direction of Case Manager or medical director.
Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively)
Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
Adheres to Compliance with PM Policies and Regulatory Standards.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Supports the administration of the hospital care, case management and quality management processes in compliance with various laws, regulations, and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.
Background Experience
2-4 years experience as a medical assistant, office assistant.
High School Diploma or G.E.D.
2 years experience in Managed Care or population health setting preferred.
Additional Job Information
Effective communication, telephonic and organization skills. Familiarity with basic medical terminology and concepts used in care management. Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Education
High School diploma, G.E.D. or equivalent experience
Percent of Travel Required
0 - 10%
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.